Provider Demographics
NPI:1588268676
Name:PERSAUD, ROCKY
Entity type:Individual
Prefix:DR
First Name:ROCKY
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 INTERNATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-7392
Mailing Address - Country:US
Mailing Address - Phone:407-355-0929
Mailing Address - Fax:407-355-0928
Practice Address - Street 1:10701 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-7392
Practice Address - Country:US
Practice Address - Phone:407-355-0929
Practice Address - Fax:407-355-0928
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty